General

The abdominal core muscles play a huge role in stability and maintaining balance during a ski. Each technique works some muscles more than others, but the core is always at work. Obtaining proper balance on the skis is the beginning step of Nordic skiing. Double poling works the upper body and core while skating and classic techniques more so works the lower body and core. Double poling works the core primarily because the trunk is constantly moving from flexion to extension. During classic and skating techniques the abdominals are working because the core is always maintaining dynamic balance through the movement of all the extremities. In addition to the abdominals, the pectorals are in constant use to push the poles away from the body propel your body forward.

Without the powder on the ground, skiing can be a difficult sport to keep up year round and to maintain the proper musculature. Roller skiing is an obvious off-season training regimen, but keep in mind other activities aid in maintaing core strength. For example, swimming is a great way to maintain the muscles you need during the skiing season. Not many sports can claim to be a full body workout, but both swimming and skiing fit the bill. Both of these sports require a strong core to be successful. Also, other major muscles used in skiing are also used in swimming like deltoids, lats, triceps, and muscles in the core in addition to the large muscle groups of the legs. Find what works for you!

Hamstring strains are very common injuries that can also cause significant pain. Hamstring strains occur when you over stretch one of the three hamstring muscles. When this excessive stretching occurs the muscle fibers begin to tear. If the fibers completely tear a rupture can occur. Hamstring strains can be caused by doing too much too soon or beyond your limits, having poor flexibility, having poor muscle strength, a muscle imbalance between the quadriceps (thigh muscles) and hamstrings, overexertion, leg length differences, an improper or no warm up, and also a history of hamstring injuries. Avoid any of those as much as possible to help prevent a strain! Below is a picture of a hamstring strain complete with some beautiful bruising!

The correct medical terms for these muscles are the semitendinosus, semimembranosus, and the biceps femoris. The Semimembranosus is the muscle that runs on the medial side (or inside) of the back of the leg. The semitendinosus muscle also runs down the medial side of the back of the leg, but is more lateral than the semimembranosus. The biceps femoris is the muscle that runs on the lateral side of the back of the leg. See pictures below to help you locate these muscles.

If you think you have a hamstring strain some symptoms you may have include:

Pain in the back of the thigh, lower buttock, or back of the knee when:

Walking

Straightening the leg

Bending over

A snapping or popping sensation in the back of the leg

Tenderness

Bruising

Swelling

Muscle weakness

Inability to put weight on the injured leg

Hamstring Strains are graded (1-3) based on the severity of the injury and the signs and symptoms of the injury. The following signs and symptoms are normally, but not always seen in hamstring strains of the given severity.

Cross Country skiing is a strenuous sport that stresses the body in many ways and exposes the athletes to numerous cold injuries. Cold injuries can affect skiers in ways that can makeor break the outcome of the race for the individual. This article will go over some of the injuries that a skier may encounter during the sport, and can serve as a guideline of how these injuries can be prevented by the athlete.

The first injury we will discuss is hypothermia, which can occur due to a decrease in the core temperature of the body and is classified as mild, moderate or severe. Mild hypothermia occurs when the bodies’ core temperature is between 95°F – 98.6°F, moderate hypothermia occurs at 90°F – 94°F, and severe hypothermia occurs at core temperatures of below 90°F. Some signs and symptoms of hypothermia include: vigorous shivering, decreased blood pressure, bradycardia, decreased motor control, cardiac arrhythmias, depressed respiration, loss of consciousness.

Frostbite can be defined as the freezing of the body tissues, and is a localized response to a dry and cold environment. Some signs and symptoms of frostbite include: dry/waxy skin, edema, tingling or burning, hard skin, white/grey/black/purplish skin, decreased circulation, throbbing pain and limited movement of the affected area.

Chilblain occurs from extended exposure to wet, cold conditions that skiers are exposed to regularly. Chilblain is an inflammatory response to the cold exposure causing restriction of the blood vessels leading to vessel inflammation, as well as edema in the dermis. Some signs and symptoms of chilblain include: red lesions, tenderness, itching, numbness, tingling and swelling.

Immersion foot occurs from prolonged exposure in cold, wet conditions typically around 12 hours or longer. Immersion foot affects the soft tissues including nerves and blood vessels, which are the results of an inflammatory response that causes high levels of extracellular fluid in the tissues. Prolonged wearing of wet socks or footwear most commonly causes immersion foot. Some of the signs and symptoms of immersion foot include: burning or tingling, loss of sensation, skin blotches, swelling, pain and blisters.

Cold urticaria is an allergic reaction to cold temperatures due to cold exposure. Signs and symptoms of cold urticaria are redness, itching, swelling and hives on the skin that is exposed to cold.

Raynaud’s disease is a condition that causes some areas of the body to feel numb and cold in response to cold stresses it is under. Raynaud’s causes the smaller arteries that are responsible for supplying blood to the skin to become narrow, which leads to a limited blood circulation to the affected areas. Signs and symptoms of Raynaud’s include skin discoloration, tingling, numbness, pain to affected areas and in rare cares ulceration of the affected area.

These injuries can be avoided if the skier takes the proper precautions to avoid them from happening. Always ensure you are staying as dry as possible and as warm as possible when exposing yourself to cold climates. If you ever find yourself affected by one these conditions, consult your medical provider to find out if you require any treatment before it is to late. Happy skiing! Stay warm!

By now, we all have tried some form of “energy” supplement out on our long skis, runs, races, etc. It can be rather confusing and difficult now that brands are expanding their variety. A multitude of flavors, caffeinated, sugar free, and densities can really seem like a lot to sort through when selecting what works for you. Below is a break down of the most popular forms of energy supplementation for endurance athletes, complete with pros and cons. See what works best for you!

Gummies: These small sports energy gummies can be found in single or bulk packet. Popular brands include Sharkies and Energy Blasts. Gummies can also come in organic flavors.

Pros: Energy chews are comparable to the chewy candy gummy bears as well as infused with energy-boosting ingredients such as those found in other energy enhancing products like energy drinks and bars. The sports energy gummies feature natural caffeine from guarana extract. They come in 60-calorie packs and hold the energy equivalence to a single energy drink; yet, without the excess of sugar and caffeine.

Cons: Since they are similar to the popular chewy gummy bear, they are often eaten as a candy instead of being used for the fuel reenergizing qualities needed for a prolonged workout.

Beans: Beans are relatively new on the market. Jelly Belly is the most popular brand to find your sports beans in an assortment of flavors.

Pros: Beans contain a mix of vitamin B, vitamin C, electrolytes, and carbohydrates. They help boost sugar levels and fuel muscles in order to provide maximum power output during exercise. There are also caffeine-infused beans for more extreme endurance needs. The single serving packets can also fit comfortably in shorts or jacket pockets without the bulkiness.

Cons: Sugar is the number one ingredient, so while the beans may do their job, they are not the healthiest choice. Evaporated cane juice is listed first in most products, which is basically sugar but cane juice is combinations of sugar such as glucose and fructose. The next ingredient is glucose syrup, which is a common sweetener in foods.

Gels: Gels are quickly being a popular staple in endurance sports. Some of the common brands you may see include: Accel Gel, Cliff Bar, GU Company, Honey Stinger, Hammer Nutrition, Power Bar, PacificHealth Labs, Vitalyte, and Carb Boom. Below are the pros/cons for the use of gels during endurance activities.

Pros: Gels are a way to provide energy to your body during endurance events. Gels are not made up of the carbohydrates that can trigger an insulin production reaction resulting in a feeling of energy loss. However, they are mostly consisted of maltodextrin or some other form of carbohydrate, which easily breaks down in the body and does not cause a sugar overload. Gels also contain trace minerals in your body (such as magnesium and potassium) that are needed by your body for muscle function.

Cons: Gels can lead to a mental dependency that you cannot finish the race unless you take one or two gels. Some people have trouble with gels if their stomachs do not handle them well. You many also experience the feeling of having too much sugar in your body.

It is always important to not take the gels too quickly and to wash them down with a few mouthfuls of water. It is also advised not to consume too many gels in a short amount of time. Two per hour or one gel every 45 min have been seen as the recommended time span between gels. This all depends on your metabolism, so another great reason to test out the gels before using them in a race.

Gum: The popular sports gum includes brands such as Gator Gum (from Gatorade) and Quench Sports Gum.

Pros: The gum is easy to transport as it comes in chunk or stick form; yet, the thirst quenching abilities of the gum have not been fully established. The process of chewing gum triggers the saliva production, which can prevent the dry “cotton mouth” feeling during long periods of activity.

Cons: Sports gum has been promoted by the ability to eliminate the sensation of thirst. However, this gum does not actually prevent dehydration. There have even been reviews of the gum actually making them more thirsty.

Since many of these products can cause stomach problems, it is also smart to train with and practice the usage of these products before an event or race.

Pills/Tablets: Electrolyte tablets are usually found in capsules (powder encased) or in tablet form. They are a concentrated substance containing electrolytes lost during exercise. Usage across the board usually recommends drinking water after consuming. Different brands include Hammer, Gu, Nuun, and others.

Pros: You can carry multiple pills or tablets in a small container, and makes easy for transportation, as long as the product stays dry. If you don’t like the taste of fluid replacement drinks, swallowing a pill and carrying water with you is a good alternative. Also, pills and tablets usually don’t contain as much sugar as a normal Gatorade/Powerade, so if sugar upsets your stomach while exercising, a pill/tablet could be a good alternative.

Cons: If you purchase tablets, you can chew them and then drink water, or drop into a bottle and dissolve for a electrolyte drink. If chewing a powder tablet or swallowing pills is hard for you on a normal basis, move towards a more liquid replenishment or a bar.

It’s important to note that if you are carrying a fluid replacement drink, those often have enough sodium and electrolyte replacement, so doubling up might not be necessary. If you select the tablet/pill route, check the sodium dosage and make sure you know how many you need to take per hour because it can vary per product.

Liquids: Liquids are premade fluid replacement beverages made to replace electrolytes, fluid and carbohydrates lost during exercise. Many different brands exist, but some include Gatorade, Powerade, Accelerade, and Lucozade.

Pros: Gatorade has a wide variety of flavors, and has established itself as a powerhouse for rehydration. This has led to many other generic brands and competitors developing products. Carrying a fluid replacement beverage can knock out the electrolyte replacement and fluid needs if digesting solid foods can upset you stomach.

Cons: If using an “original” formula of a fluid replacement beverage, often times the sugar can be higher than 20 grams for one serving. Again, if you know you have a sensitive stomach to sugar, experiment with the reduced sugar or sugar free options.

Since fluid replacement beverages can be appealing, it often times is substituted as a drink during the day when not exercising. This can be detrimental to an athlete because of all the excess carbohydrates found in a bottle.

Pros: Bars are often great for recovery AFTER exercise since they are high density foods with a decent ratio between protein and carbohydrates. A Clif bar can be beneficial however during a very long bout of exercise when large amounts of calories are being lost, just be careful to experiment before competitions to see how your body reacts.

Cons: Consuming bars during exercise, especially without liquid, can cause distress in the athlete. Plus some bars contain high amounts of fiber, which can lead to gastrointestinal distress. Also, competing in cold weather activities (such as cross country skiing!) these bars freeze and become nearly impossible to consume.

Asthma is a condition in which breathing becomes very difficult. Symptoms common to experience include coughing, wheezing, and chest tightness. Asthma severity can range from person to person. Symptoms often arise when exercising, which is called exercise-induced asthma. This can occur when air is cold and dry such as when one may experience while out skiing.

Risk factors for asthma include having a blood relative with asthma, having an allergic reaction, being overweight, being a smoker, exposure to secondhand smoke, having a mother who smoked while pregnant, exposure to exhaust fumes or other pollution, exposure to chemicals, or low birth weight.

One must seek emergency medical attention if rapid worsening or shortness of breath or wheezing occurs, if no improvement after use of a quick-relief inhaler, or shortness of breath after only minimal physical activity.
A few home remedies or changes to your daily life to help keep asthma in check: avoid your triggers, use your air conditioner, decontaminate your decor, maintain optimal humidity, prevent mold spores, reduce pet dander, clean regularly, and cover your nose and mouth if it’s cold outside. Another good way to keep asthma at bay is to continue skiing regularly, maintain a healthy weight, eat fruits and vegetables, and control heartburn.

If you are alone and experiencing an asthma attack or with an individual having an asthma attack, maintaining calm is the best tool. Simple breathing exercises can help by taking slow, shallow breathes through the nose. Ordinarily, asthma attacks occur when the individual panics and breathes as quickly and deeply as possible.

Breathing rate is controlled by the amount of carbon dioxide (the gas that regulates the acid-base level of the blood), not the amount of oxygen in the blood. Therefore, a method to treat an asthma attack is to have the person with the attack breath into a paper bag (such as a brown paper lunch bag) of some sort to increase the amount of carbon dioxide in the body. This old trick in the movies really works!

If the person has an inhaler, help them find it, instruct them to use it, and continue to have them remain calm and control their breathing until breathing has returned to normal. If breathing cannot be controlled or returned to normal, even after the use of an inhaler, it becomes an emergency situation and one must seek medical attention. One must seek emergency medical attention if rapid worsening or shortness of breath or wheezing occurs, if no improvement after use of a quick-relief inhaler, or shortness of breath after only minimal physical activity.

Concussions can occur at any time and any place. A concussion is a traumatic brain injury that is caused by a blow to the head or body, fall, or another injury that jars or shakes the brain inside the skull. In some cases, a concussion can even occur without any impact to the head itself (whiplash from a car crash, or crashing on roller skis). If an injury occurs the results in cuts or bruises on the head or face, there may be no visible signs of a brain injury. Concussions are often overseen, since many people believe there must be loss of consciousness to have a concussion.

With rest, most people recover fully from a concussion. Recover can take a few hours, days, or weeks. In some rare cases, repeated concussions or a severe concussion may require surgery of lead to long-lasting problems related to movement, learning, or speech. Due to the possibility of long term problems, it is important to be able to diagnose a concussion immediately and seek medical assistance.

Symptoms of a concussion can be mild to severe and for hours, days, or weeks depending on the severity of the injury. The categories symptoms fall into are thinking and remembering, physical, emotional and mood, and sleep. The thinking and remembering symptoms include: not thinking clearly, feeling slowed down, not being able to concentrate, and not being able to remember new information. The physical symptoms include: headache, blurred vision, nausea and vomiting, dizziness, sensitivity to light or noise, balance problems, and feeling tired or having decreased energy. Emotional and mood symptoms include: being easily upset or angered, sadness, nervousness or anxiousness, and being more emotional. The sleep symptoms include: sleeping more than usual, sleeping less than usual, and having a hard time falling asleep.

There is neurological testing and a cognitive assessment that can be performed if a concussion is suspected. The neurological portion consists of testing cranial nerves. I have mentioned these nerves and how to test them in a previous post, but here they are again. Cranial nerves are labeled 1-12: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal. Each nerve tests a different sensory, motor, or mixed function. Depending on the nerve or function that is damages, the area of injury to the brain can be more focally localized.

2 – Optic: tests vision – can you see the tree down the mountain or the tree right in front of you

3 – Oculomotor: tests reaction to light and eye movement – look at pupils while passing a light in front of the eyes and following a finger down and in (from lower corner to center of sight) with just the eyes, test both eyes

4 – Trochlear: eye movement – follow a finger up and out (from center of sight to upper corner) with just the eyes: test both eyes

The cognitive assessment includes red flags such as unusual communication, inappropriate behavior, irrational thinking, mental disability, or personality changes. Recall and memory can be tested for retrograde (prior to event) or anterograde (since event occurred) amnesia. Amnesia is a deficiet in memory caused by brain damage or trauma. Retrograde testing can include asking the time (what time of the day is it?), place (where are you?), person (who are you? what is your full name?), and purpose (what are you doing here?). Anterograde is usually only affected by more severe head injuries. Anterograde is checked by telling the person 3 words in the beginning of the assessment (such as apple, snow, bubble). Have the person repeat the words back after the neurological and retrograde testing. The affected person can also test analytical skills by counting down by 7’s from 100; spelling the word ‘world’ forward and backward; and saying the months of the year backwards.

Treatment of concussions is very conservative. While symptoms persist, the indivdual should avoid all brain stimulation. Stimulation includes homework, reading, watching tv, and looking at a computer. There must be no symptoms before light aerobic activity can take place. Progression daily from light to moderate to heavy activity must take place. Each day the activity level increases as long as symptoms do not return. It is better to be cautious when it comes to the brain. When in doubt, seek medical assistance

It’s not too often skiers are diagnosed with Achilles tendinitis, but it can happen, especially during running intensity the athlete isn’t accustomed to, tight calf muscles (gastrocnemius and soleus), improper form, or ill fitting ski boots and shoes. Ideally any exercises performed should be pain free, so adjust accordingly.

Before taking on a rehabilitation program, first try to control the pain in your Achilles tendon. Depending on the stage of your injury, a multitude of options are available. Lots of heel stretching (See previous post, Part 1 of “Am I Imbalanced?”), icing after workouts, NSAIDs (ibuprofen), and massaging are good options to start with to control pain. Compression socks are also very popular to wear if activity isn’t too aggravating.

Through my experiences, I have found that eccentric exercises usually produce success in getting athletes back to full strength. Eccentric means an athlete is working on strengthening the muscle in an elongated position. Think of it this way, you are bench pressing and push the bar up quickly in a 2 second count, but you lower it to your chest slowly in a 4-6 second count. These types of exercises are often referred to as “negatives”. Another common example is when female athletes are unable to perform large numbers of pull ups, they can start with a negative pullup (getting a boost to hold themselves at the top of the bar, then lowering their bodies down in a 10 second count). Below are some great eccentric Achilles exercises to perform.

Exercise 1, “Heel Drops”: Find a box, or anything high enough and sturdy enough to stand on. This exercise is pretty basic, and is essentially taking calf raises and reversing them. Start by placing your heels off the back of the box, make sure to have a wall or something to hold onto so you don’t lose your balance. Drop your heels into the starting position, do a calf raise up in a 2 second count, and then lower yourself down slowly in a 6 second count back to the starting position. Repeat this at least 15 times, if possible perform 20.

Exercise 2, “Single Leg Board Squats”: Find a slanted board if possible, and set against a wall so it doesn’t slide around as you move. Plus, holding to the wall for support will help with balance and safety. Stand about midway on the board on just your toes, pick which leg you want to start with. In an upright position, lower your body in a 6 second count to the bottom of your range of motion, then push up on your toes in a 2 second count. If you can perform this in front of a mirror, that will be helpful to make sure your knee is staying in a straight line, and not moving all over. The key to this is to not let your heel touch the board. Do 10 repetitions on each leg, add another set if you feel able.

Exercise 3, “3 Dimensional Lunges”: This exercise is not as focused on the eccentric aspect, but proper form and hitting all ranges of motion. Focusing on the three dimensions the body operates in is sometimes overlooked in rehab, and can be a secret to success. To start, go forward into a lunge position. On the return push back, really focus on using that calf in the behind leg to bring yourself back. Perform these squats slowly, it’s not meant to be explosive in anyway. After going forward with the lunge, step into the next lunge but aiming to the left. At a 45 degree angle. Return to the center, and the lunge to the right at a 45 degree angle. Going the three ways counts as one set, repeat 10 sets on each leg.

See video below for how to perform, just do it without the rotation.

Variation on Exercise 3: While performing the three different motions, a rotational aspect at the hips can occur as well. We do this because it turns the hip into internal rotation, which translates the tibia (shin bone) creating a different pull on the muscle. Hitting all these dimensions of the Achilles will properly ensure even strengthening throughout.

Well, the ski season is over for most of us and spring is coming out. Now is the time to find those other extra curricular activities to spend time with. This post is inspired by a fellow ski friend of mine that displayed some odd behavior the other day. Picture this scenario, you’re roller skiing and your buddy decides he is too cool for his helmet, and takes it off. One pot hole later, and he’s laying in the street seeing stars and is losing sensation in his face. In the realm of athletic training, there are functional tests we ask athletes to perform to make sure all twelve cranial nerves are working optimally. Usually these are damaged with blows to the head, but crazier things have happened. Here are the twelves nerves, and how to test them

I. Olfactory- Sense of smell, to test: take a swab of rubbing alochol, a sweaty ski boot, something pungent, etc

II. Optic- Vision, to test: Pick words at a distance for them to read

III. Occulomotor- Vision, to test: Remove the Rudys, cover one of their eyes, move hand and see if the pupil returns to normal

IV. Trochlear- Vision, to test: Take your finger and move it from side to side and watch their eye tracking

V. Trigeminal- Facial sensation, chewing, to test: Have them clench their jaw, or try to open their water belt with their teeth

VI. Abducens- Vision, to test: Take your finger and move it diagonally watching eye tracking again

As athletic training students, and any other allied medical area of study, acronyms are used all the time. Early on in my studies we learned the acronym FOOSH to remember the mechanism of injury (how an injury occurred to cause it) of many wrist pathologies. I thought this post would be good because of Holly Brooks recent wrist injury could have occurred from a FOOSH. Alright, so what is FOOSH?

FOOSH: Falling On (an) OutStretched Hand

We’ve all probably heard this before, but when you are falling you’re supposed to roll or let your body absorb the fall? The last thing you want to do is throw your arm straight out, stiff as a board, to try and catch all of your body weight. Last time I checked your body weighs a lot more than one arm. Of course, we don’t have much time to process how to soften our fall as we are doing the said falling. This causes us to hurt our wrists! FOOSH can lead to multiple injuries including, but not limited to: TFCC injury, dislocation of the lunate bone, Kienböck’s Disease, scaphoid fracture, hamate fracture, strained wrist ligaments, etc

Don’t think that since we are skiers we are safe from this injury! I was cheering on some junior skiers, and chatted with a boy who did the exact thing I am describing.

See the large glove and padding attached to the pole? FOOSH injury, he was protecting his cast underneath.

We all have had our fair share hearing about a famous American football player or basketball player tearing their ACL and having to quit their season. The words “ACL tear” have such a stigma attached to them, people cringe just at the sound of it. Luckily for us uphill skiers, we don’t have to worry about tearing our knee ligaments too often, but don’t rule it out.

In case some of you didn’t know, there are four major ligaments of the knee: ACL, PCL, LCL, and MCL. To help you understand why these ligaments are so important, I’ll explain them all.

ACL: The ACL, also known as the Anterior Cruciate Ligament is found in between the menisci of the knee and crosses (hence the word cruciate) with the PCL. The ACL itself is made up of three bands: the anteromedial, intermediate, and posterolateral. The ACL prevents the femur (thigh bone) from moving posteriorly (backwards) when you are putting full weight on your leg. It also limits your tibia (shin bone) from anteriorly (forward) when non weight-bearing. One of the ACLs biggest supporters is the hamstring tendon group. Commonly if someone chooses not to get a skin graft to repair their ACL, they have to go through extensive rehabilitation to regain stability of their knee. Strengthening the hamstrings is one way to help add stability to the knee again.

PCL: The PCL, or posterior cruciate ligament, isn’t often completely torn because it is stronger than the ACL. It’s main function is to help prevent hyperextension of the knee. Often times tearing of the PCL is referred to as a “dashboard” injury because people who are involved in car accidents are prone to tear their PCLs when their knees hit the dashboards of their car on impact. Be careful skiing with your knees bent going into the trees!

MCL: The MCL, or Medial Collateral Ligament, attaches on the medial (towards the center of the body) epicondyle (bony protusion) of the femur (thigh bone) to the tibia (shin bone). The MCLs main function is to stabilize the knee when in a valgus position. To explain this, imagine you just took a step forward with your right foot, and someone kicked your ankle from the inside. Your foot goes out to the right at a funny angle. Most likely the next day you will feel some soreness on the inside of your knee, which was from your MCL possibly being torn from the valgus force that was produced.

LCL: The LCL, or Lateral Collateral Ligament, can be felt the easiest out of all the ligaments. Athletic trainers will often put athletes into the “Figure 4″ position to palpate the LCL. Either sitting or standing, bring your foot up and try to touch your opposite knee. Almost like you are sitting with one leg crossed. With practice, you can palpate your own LCL! The LCLs main function is to protect the knee from varus forces. (Imagine the same scenario from before, but someone kicking you from the outside, and pain presenting on the outside of the knee). Other structures that support the LCL include the IT band.

Most commonly, an injury to these ligaments occurs when the knee is forced into a position it isn’t naturally supposed to go into. The sports with high impact have this occur more often than cross country skiers do, but our relatives aren’t as lucky. Injuries to these ligaments is more common in downhill skiing because of the falls that can occur. Basically, if you can stay on your feet and are striding and gliding normally, you shouldn’t be at risk!